The Role of Plasmid and Resistance Gene Acquisition in the Emergence of ST23 Multi-Drug Resistant, Hypervirulent Klebsiella pneumoniae

Abstract

Hypervirulent Klebsiella pneumoniae (hvKp) has become the dominant pathotype in hospitals recently. The sequence type (ST) 23 hvKp, which are more commonly associated with the community-acquired infections previously, may have the capacity to acquire multidrug-resistant (MDR) phenotypes creating a new “superbug” (MDR-hvKp) in hospital.

Emergence of Extensively Drug-Resistant and Hypervirulent KL2-ST65 Klebsiella pneumoniae Harboring bla KPC-3 in Beijing, China

“…The other O loci, such as O1v2, that emerged in the study, should be sources of concern. The presence of iroB , iucA , peg344 , rmpA , and rmpA2 together is highly accurate for the identification hvKp, and we found that most of the ST65 genomes (83.0%, 78/94) harbored these five key virulence genes, suggesting that ST65 is a classic hvKp possessing a pLVPK-like plasmid, similar to ST23 ( 8 ). Among our 10 isolates, although the 5 above-described virulence genes were all positive, 3 isolates, P6, J4, and PEP3083, were negative for clb and ybt genes and received a virulence score of 3 with Kleborate software, whereas the other 7 isolates with clb and ybt genes had a score of 5.…”

“…Most hvKp strains possess a thick capsule that serves as a barrier for the uptake of external genes ( 7 ). However, the typical hvKp strain, ST23, tends to acquire antimicrobial resistance genes via the plasmid and IS 26 , resulting in MDR-hvKp ( 8 ). Interestingly, bla CTX-M-like , not bla KPC or bla NDM , is common in MDR-ST23-hvKp ( 8 ), which is different from the ST11 endemic clone ( 9 ).…”

“…However, the typical hvKp strain, ST23, tends to acquire antimicrobial resistance genes via the plasmid and IS 26 , resulting in MDR-hvKp ( 8 ). Interestingly, bla CTX-M-like , not bla KPC or bla NDM , is common in MDR-ST23-hvKp ( 8 ), which is different from the ST11 endemic clone ( 9 ). To date, research on MDR-hvKp within ST65 has been extremely scarce.…”

Genomic Analysis of Multidrug-Resistant Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae Strain Lacking the Hypermucoviscous Regulators (rmpA/rmpA2)

“…Our isolate harbored an IncF plasmid, insertion sequences, and phage-associated proteins at regions containing ARGs and virulence genes, which reflect their possible role in the horizontal gene transfer and dissemination of such strains [16]. The IncF plasmids are thought to play a significant role in the acquisition of MDR genes [34,35], which could increase the chance for the acquisition of genes such as the bla KPC carbapenem resistance gene.…”

Clonal Dissemination of Multidrug-Resistant and Hypervirulent Klebsiella pneumoniae Clonal Complex in a Chinese Hospital

“…However, the adaptation and prevalence of hvKp in healthcare settings has become a recent threat [ 5 , 25 ], worsened by the high resistance of clinical strains [ 24 , 26 , 27 ]. While hvKp subtypes like CC23 commonly causing community-acquired infections have been more and more common in hospitals in recent years [ 28 ], a high proportion of CC258 isolates have been acquiring virulence plasmid becoming hvKp [ 3 , 4 ]; it was also observed that other common subtypes of cKp have obtained the virulence plasmid [ 5 ], becoming high antimicrobial-resistant hvKp themselves [ 26 ]. In this study, we found that among the four CC15 lineages, two clades in two different lineages obtained the pLVPK-like virulence plasmid independently, and one of them had the bla KPC-2 gene, becoming cr-hvKp.…”